Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003185489 |
---|---|
Provider Name | Melissa Marie Moss |
First Address | Tacoma, WA 98407-3715 |
Second Address | Tacoma, WA 98407-3715 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2011 |
Last Update Date | 14/12/2011 |